多重耐药鲍曼不动杆菌的聚类分析与病例调查  

Cluster analysis and case survey of multidrug-resistant Acinetobacter baumannii

作　　者：王敏[1,2] 曹加[1,2] 梅亚宁 欧宁[1,2] 

机构地区：[1]南京医科大学第一附属医院药学部,江苏南京210029 [2]南京医科大学药学院,江苏南京211166 [3]南京医科大学第一附属医院检验学部,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2014年第6期820-825,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生厅科研面上项目(H201305);2012年度医院诊疗新技术新项目(院发187号文);科技部科技重大专项"重大新药创制"(2011ZX09302-003-02);江苏高校优势学科建设工程资助项目(JX10231801)

摘　　要：目的：了解多重耐药鲍曼不动杆菌（multidrug-resistant Acinetobacter baumannii,MDRAB）的同源性与流行病例,为控制医院感染及临床合理用药提供依据。方法：收集2012年6-12月临床分离的31株MDRAB,采用K-B纸片法检测12种抗菌药物敏感性,应用脉冲场凝胶电泳（pulsed field gel electrophoresis,PFGE）分析菌株的同源性。回顾性分析MDRAB样本病例。结果：药敏结果显示,31株MDRAB对9种抗菌药物100%耐药率,包括4类抗菌药物。PFGE结果表明,31株菌分为5个克隆,20株属于B克隆,占64.52%,为主要流行菌株型,分布于8个病区,主要集中在重症监护病房、胸心外科、老年重症监护病房等重症病区。患者平均年龄64岁,侵入性操作占97%。结论：MDRAB对临床常用抗菌药物耐药比较严重。可能与院内存在克隆传播及患者年龄大、侵入性诊疗操作、合并多种基础疾病等多种因素有关。Objective：To investigate the homology and prevalent cases of multidrug-resistant Acinetobacter baumannii（MDRAB）so as to provide reference for the prevention of nosocomial infection and clinical reasonable application of antibiotics.Methods：A total of 31 MDRAB isolates between June 2012 and December 2012 were collected,the susceptibility test of 12 antimicrobial agents was determined by K-B method,and the homology analysis of the strains was determined by pulsed-field gel electrophoresis（PFGE）.Retrospective analysis of MDRAB sample cases was performed.Results：The antimicrobial susceptibility showed that the resistance rate of 31 MDRAB isolates to 9 antibiotics was 100%,including 4 kinds of antibacterial drugs.The results of PFGE demonstrated that31 isolates were classified into 5 distinct genotypes,among those 20 isolates（accounting for 64.52%） of clone B were the predominant epidemic strains.The patients with MDRAB infection were distributed among 8 wards and mainly centralized in the intensive care unit,cardiothoracic surgery and geriatric intensive care unit.The average age of the patients was 64 years,and 97% of them had undergone invasive procedures.Conclusion：The MDRAB was seriously resistant to almost all clinically-used antibiotics.It may be closely related to a variety of factors,such as clonal spread,old age of patients,invasive treatment and patients with multiple underlying medical conditions.

关 键 词：多重耐药鲍曼不动杆菌 脉冲场凝胶电泳 聚类分析 耐药性 病例调查 

分 类 号：R446.5[医药卫生—诊断学]